“Cesarean vs. VBAC: A Dramatic Difference” (video by Alexandra Orchard: inspiring for those seeking VBAC, but if you’re squeamish you should be forewarned that the video includes graphic footage of two c-sections)
What’s the difference between “pain” and “suffering”?
Pain and suffering are not the same thing. ‘Birth usually hurts’ doesn’t have to equal ‘people giving birth suffer.’ Why? Okay, so: we have the physical sensation of pain, and then we have the emotional experience of suffering, which are sometimes but not always related. It’s obvious that I can suffer–feel fear, distress, lack of control, sadness, regret, and/or other ‘painful’ emotions–without physical pain (because someone betrays me, a family member dies, I make a mistake, I have upsetting memories or dreams, etc.). Yet people often assume that the opposite is untrue–that physical pain is always accompanied by suffering. Birthworkers–particularly supporters of low-intervention birth–tend to disagree: I know, for instance, that I can feel not only suffering without pain but also pain without suffering. Although much of my own labor was quite painful, I only experienced suffering during transition. People also experience pain without suffering in other parts of life: during exercise, for instance. (Or so I hear.)
Some things to consider: Do you want at least one person in the room paying attention to you (your face, your emotions) instead of to the machines and screens around you? Do you want someone with you the whole time, awake when you’re awake? Do you want someone to take notes for your birth story? To massage your feet, shoulders, and hands? To ‘hold the space’ by keeping the lighting, noise level, music, etc. however you want your and your baby’s birth experience to look/sound/smell/feel? To help you seek information and explanations? To fetch you things you need, since you won’t be mobile yourself? To help you change position regularly? These are all things your labor partner / support people can do for you. Some women find that hospital staff and support people become physically and emotionally distant as soon as pain relief is established, but of course labor is not solely or even primarily about pain.
The short and unsatisfying answer: the sensation of crowning varies wildly, like all the sensations of pregnancy and birth—some women experience very painful burning (“the ring of fire”: sounds lovely …), while other experience a mild stretching sensation or even pleasure.
I know a lot of women who have assumed from adolescence that they would have an epidural during childbirth, some of whom are well-educated about that decision and some of whom imagine that having an epidural means they’ll somehow have a completely pain-free and safe birth. I think everyone understands why some women choose to have various pain medications during a painful and, for many, scary experience; it’s not exactly inexplicable to think “hey, I’m in pain; can I have some pain medication?” But, on the other hand, a lot of people have absolutely no idea why anyone in her right mind would choose to experience birth without pharmaceutical interventions to manage pain. From “I could never do that” to implications that unmedicated childbirth is masochistic and/or sadistic, many responses to this choice seem to imply that their utterers are at a loss to explain such bizarre behavior.
So, judging from my own experience, other people’s stories, and books and articles that deal with choices in childbirth, here are some of the reasons that some non-masochistic women might prefer to avoid drugs while they labor, with the help of their non-sadistic yet supportive partners/caregivers/doulas:
A woman who’s spent pregnancy avoiding various chemicals (alcohol, caffeine, nicotine, the wacky stuff in household cleaning products, hormones in nonorganic milk, over-the-counter medications, or whatever), and plans to avoid an assortment of potentially hazardous things around her new baby, may not want to expose her fetus-rapidly-becoming-a-baby to drugs that cross the placenta.
A woman who’s committed to breastfeeding and/or who’s had problems with it in the past may not want to risk certain interventions (including an epidural) possibly making that process more challenging.
A woman who’s disturbed by the idea of an episiotomy (and healing from that cut while taking care of a newborn) may not want to risk a possibly increased chance of that procedure by requesting or accepting an epidural.
For a range of emotional, financial, cultural, and other sorts of reasons, a woman may want to give birth in a birth center or at home, where most or all forms of pharmaceutical pain relief are unavailable. She may already want an unmedicated birth for other reasons anyway, or the environment may simply be important enough for her to forgo access to these interventions except in case of a shift to a hospital birth for medical reasons.
A woman may view labor as an experience unto itself. For instance, she may look forward to it as a new way to use her body, an opportunity to experience her own strength and endurance, a meditative or otherwise transcendent process, a passionate shared adventure with her partner, or a chance to heal wounds in her relationship with her own body and/or sexuality. Such a view of birth (as a desirable experience as well as a means to a baby) may mean she wants the whole, unmediated set of sensations and perceptions. It may also mean she wants the whole challenge.
A woman may conceptualize suffering as quite separate from pain, as do lots of neat birthworkers including Penny Simkin. (Allow me a digression.) Okay, so there’s the physical sensation of pain, and then there’s the emotional experience of suffering, which are sometimes but not always related. It’s easy to see that I can suffer–feel fear, distress, lack of control, sadness, regret, and/or other rough emotions–without physical pain (because someone betrays me, a family member dies, I make a mistake, I have upsetting memories or dreams, etc.). Although we often assume that the flip side is untrue–that physical pain is always accompanied by suffering–I’m with Simkin and others who disagree. I know I can feel not only suffering without pain but also pain without suffering, because although much of my own long labor was quite painful, the only time I experienced suffering was during my long and disorienting transition phase. So, a woman might believe in her ability to deal with pain without suffering and see labor as an experience that can involve no or little suffering. This attitude may actually help her stay relaxed and in fact experience less pain than she would if she were tense and frightened.
A woman may simply not fear pain, or she may fear pain a lot less than the other forms of suffering she thinks childbirth could potentially involve. If she is less worried about pain than about loss of control over her body or her experience, the triggering of an abuse/rape memory, being stuck in one place or connected to machines (a sense of being trapped or tied down), or another issue, she may choose to avoid any interventions that might bring it into her birth experience. I think it’s important to remember that pain is not the worst possible thing for most people, even if our medical system often implies that it is.
Similarly, a woman may fear the potential side effects of a particular intervention more than she fears the pain it’s supposed to fix. Some interventions can cause lovely experiences such as full-body itching or anxiety and dissociation, both of which sound infinitely worse to me than the most intense pain of my own labor. Of course, some women would take itching or anxious confusion over intense pain in a heartbeat; we just all have legitimately different priorities and concerns.
A woman may want to avoid a possible ‘cascade of intervention,’ meaning the possibility that one (elective) intervention could potentially lead to lots of other (either elective or medically necessary) interventions that she did not want.
She may feel strongly about meeting her baby with both of them completely free of a drugged, sluggish, or foggy feeling, excited to experience the full rush of oxytocin and birth euphoria.
Or she may simply believe that often the best thing to do is nothing, and want to let labor take its course without unnecessary interventions. If her normal way of being in the world is to choose stillness and quiet awareness over hectic action in intense situations, she may choose to have a low-tech birth.
Okay, I’ll stop. There are other reasons, too; these are just some that come to mind for me. Most women who plan unmedicated births probably do so for multiple reasons (I certainly did). None of these reasons applies to everyone or means that all women ought to want unmedicated births. But I do hope they illustrate that the choice can be a reasonable, valuable, earnest one that should be honored on its own terms rather than dismissed, and that it can mean lots of different things to different women, just like every choice in childbirth.
Two years ago today, I gave birth to my first (and, so far, only) child. I recently reread my birth story, which I wrote during the couple days after the birth (based on my memories and my husband’s detailed notes) and have copied below without any changes. It’s so moving for me to read this narrative and feel all those feelings again, to live with myself through the long, hard labor and triumphant shift into pushing and then new life, and to witness again my partner’s almost-unbelievable attention, competence, and kindness.
But it’s also fascinating to read my own story now that I know so much more about it. All these details are correct, but now I know what they mean in a way that I didn’t at the time. I know how amazing it is that these midwives let my body do what it needed to do. I notice that my least pleasant memories correlate awfully strongly with the very few interventions we did do, all in a totally good-faith effort shared by our caregivers and us to keep me out of the hospital in a system that does not accept more-than-two-weeks-’overdue’ and several-days-long, “stalling” labors (various ‘natural’ induction efforts when my body and fetus may not have been quite ready but were teetering at the brink of the birth center’s protocol at two weeks past my ‘due date,’ AROM (‘breaking my water’) leading to intense transition when my body and the fetus’s position were maybe not ready to go there yet, low-dose Nubain ‘to help me rest’ that I now suspect led to the disorientation and confusing hallucinations that can be a side effect of that drug). I realize how strange and challenging it was to spend over a complete work day in transition. I see how parts of my labor were ‘back labor,’ and understand how hard it would be to experience that throughout an entire labor. I hear the midwife, so pleased to find that my cervix had finally dilated almost completely, telling me that I could push and asking if that’s what I wanted to do. I hear what I didn’t write down–both midwives letting me choose whether and when they performed pelvic exams, without exception. Indeed, I hear everyone involved in this story asking me, after every suggestion and each of my questions, what I wanted to do.
Most of all, I now cherish–in a way I didn’t know I needed to do, back when this story constituted my entire knowledge of our birth culture–the long minutes of absolute silence and the respectful, kind, soft words that surrounded my son’s birth. The calm of my husband and caregivers. The simple, earnest answer I received a couple weeks ago from my husband, when I said I have become amazed at all the beautiful silence: “Well, we were all paying attention to you.” As in, how could we have had the attention to attend to you and make a bunch of noise at the same time? As in, what noise would we have been making while you were busy bringing a child into the world, perfectly, on your own but surrounded by support?
That’s exactly right, sweetheart. (And happy becoming-a-parent day to you!)
And yet so many births in our culture–even low-risk, unmedicated births–are as brightly-lit as surgeries and as loud as sports events, in rooms overflowing with strangers in masks carrying ‘implements,’ and not a soul paying any attention to the laboring woman’s feelings, words, or face. I am so fortunate and so happy in my birth memories; they make me feel nothing but strong and loved.
Here’s our story.
Noah was born at 2:58 on the morning of Friday, 14 July 2006, two weeks and four days after his 26 June due date and after a fifty-one hour labor. I was amused to see later that morning, on the birth certificate form in the statistical section, that my labor is classified as “extended” and “dysfunctional.” Apparently anything over twenty hours is “extended,” so we certainly made that one—we were already at the birth center twenty-two hours before Noah actually emerged into the outside world. My labor was the most painful and among the most difficult, but also among the most fulfilling and romantic, experiences I’ve ever had.
Eric and I went into the labor exhausted because, by necessity, we’d been increasingly obsessed with the pregnancy and whether it was in fact ever going to end. By Noah’s birth, we had been at the birth center every day for six consecutive business days for various check-ups and tests and had gone to the hospital for two ultrasounds to monitor my amniotic fluid level and how well my aging placenta was working. We had tried a number of more or less natural induction methods, including getting up at 5:30 on Tuesday morning for me to take castor oil, which resulted in more contractions and lots of stomach unpleasantness but not labor. That was the beginning of our serious sleep deprivation; at midnight that night my labor began, although it would stop progressing three times before the birth, and in the three and a half days from 5:30 Tuesday morning until eight o’clock Friday evening I would get about six hours of sleep, most of that punctuated by contractions every few minutes and thus not really ‘sleep’ in the traditional sense of being restful. Eric was in about the same boat as me. And I had insisted on walking and walking and walking in the last days of my pregnancy and then through almost all of my contractions.
By Wednesday morning my contractions had progressed from about every six minutes to about every four minutes, and we were excited; we had been told we’d go to the birth center when they were patterned at about three minutes apart. The midwife on call suggested we come in around nine o’clock when Maureen’s shift started, so she could check me and we could make a plan. I had made progress, and Maureen suggested we get a little rest before coming in (as, presumably, my labor continued to progress); I took two Tylenol and a Benadryl as directed and at first had rather nightmarish sleep broken up by searing contractions. But after noon or so I woke shocked to find that it was two o’clock. My contractions seemed to have stopped, and, both very worried, we called Maureen about this stalled progress. At this point Eric was already saying he had never seen me so exhausted. I had called my mom that morning, when birth looked relatively imminent; she arrived at the airport at three o’clock, and our friend Jennifer picked her up and brought her to our apartment to find us out walking—which had sometimes sped up my contractions and gotten them into a clearer pattern.
I continued to have scattered rather than patterned contractions, some quite painful and some just uncomfortable, usually between six and fifteen minutes apart, until they picked back up around nine o’clock that evening. By three that morning I hurt significantly and, though my contractions were still about six minutes apart, called the birth center for help with pain management. I had taken showers but not yet a bath (out of fear that it might again slow my labor), and Jill, the nurse on call, suggested that a bath could be helpful. During that bath as my contractions intensified and sped up to intervals of 3-5 minutes; all along my contractions had lasted about 75 seconds to two minutes each, so they never did really progress in terms of length. Anyway, Eric read to me from The Hobbit part of the time, and he sat at the edge of the tub and helped me as I wiggled and swayed through these increasingly intense waves, some of which peaked twice, always an unpleasant surprise. I stayed in the tub most of the time until nearly five, when Eric noticed that the contractions had sped up considerably and timed five more; I called the birth center again and was told to come on in. I called my dad and Eric called Jennifer, who left to meet us at the birth center; on the way, Eric also called his parents. When the three of us got into the car (Mom next to the car seat we’d been driving around for five weeks already), I popped right back out to walk through another contraction because I knew I hated being pinned helplessly into the car during that pain. I was grateful to have such a short drive and only to have one contraction in the car, another starting as we pulled into the parking lot.
We walked in to find Maureen and meet Jill, and to find me dilated yet another centimeter (5-6 at this point), 100% effaced, and at zero station. They drew me a bath, and Eric turned on our wedding music. (Hours later I asked him to play Finding Nemo in the background, and we ended up listening to our wedding music about three times.) He smiled and told me it was my time to shine. At 7:30 I threw up for the first time and was already trying to use the birth ball a little as a break from walking; I ended up mostly laboring walking, but occasionally between or during contractions I would try to rest by being on the ball (or by propping myself up, nearly standing, against lots of pillows on the edge of the bed, ready to start walking again when the pain began). I sometimes jumped up from the pain, which I only really found manageable with my body upright and in motion. Jill and Maureen watched me work through a couple contractions, apparently to see whether it was really a good idea to follow our birth plan and leave us more or less alone until we asked for help (or whether we needed some advice or coaching before that); Jill told us we seem like a great couple and told me, “You seem like a pro. You wouldn’t know this was your first baby.” At eight o’clock Maureen and Jill were replaced by Heather and Cheryl. By 10:30 I had dilated another centimeter and was pleased to be making real though gradual progress.
It’s hard to believe now that by eleven that morning Heather had already offered me a little Nubain for my pain and exhaustion; I said I was okay for the time being. For a while we had both been tired enough to pass out for the moments between contractions, but as it got to be a time of day when we’re normally up and alert, we became more lucid. At noon Eric and I still felt confident and optimistic and could see my belly dropping significantly—I remember seeing my profile in the mirror and pulling up my grey t-shirt to observe that my belly had sort of a flat shelf on top where everything was lower, and Eric noticed that I was bulging over my hip bones rather than under my ribs. Heather and Cheryl kept telling me how well I was doing when they came in to check the fetal heart rate (always very strong) and so forth. I just kept walking, up and down the room from the bathroom door back to the sink, and around the rocking chair / birth ball area we’d set up. Near one o’clock we felt upbeat enough to laugh and dance briefly to a Louis Armstrong song, and soon we found I was at eight centimeters, though still at zero station. I remember asking at that point something like, “A lot of women go from eight to ten really quickly, right?” and Heather saying yes, that’s common. Again, we were excited and ready to go. We had come into the birth center guessing we’d have a baby by noon or so, and now we thought surely it would happen by five.
But at 4:30 that afternoon I was still at eight centimeters, and for about half an hour my contractions had stopped getting more intense and instead became less patterned; I would have two or three one right after the other and then several minutes before the next one. Heather discussed possible interventions with us—black and blue cohosh drops, which would take a long time either to work or not to work; using a breast pump to stimulate contractions that hopefully would be more productive and organized; breaking my water; or going to the hospital for a pitocin induction and/or cesarean section, which we all hoped to avoid. Pumping usually works and has no particular downside in that we could try the other methods if it failed to get me progressing, so that was our choice. Heather told us that she or Cheryl could help me use the pump, or that they could show us how and Eric could help me. So Cheryl explained how it worked, and I sat on the birth ball facing Eric in the rocking chair while he read more from The Hobbit to distract me when possible. (One of the enormous benefits of the birth center was that they actually read and honored our birth plan, including our desire to be alone together and my request that they always knock before coming into the room. Eric and I had real privacy during this experience, which I think is unusual.) We were supposed to do ten minutes on, ten off, until the contractions pulled together or for an hour. The first twenty minutes involved several normal, intense contractions and were encouraging, but the second time, I just contracted straight through the ten minutes of pumping. We told Cheryl, who said we needed to stop because my body was responding too strongly and that contractions that long weren’t good for anybody. We were encouraged, though, to find my contractions back to their former intensity and frequency. Around six o’clock, Cheryl told me that my dad had called, that they couldn’t give him much information but told him I was still in labor there and working hard, and that he sent his love; he later told me he knew they wouldn’t be able to tell him anything but also knew that if I was still at the birth center, I was okay.
Meanwhile, everyone was hoping that the fetus, who didn’t seem to want to become a baby, would turn from a sideways position. We tried manipulating my belly during and between contractions; staying still and being messed with during contractions was extremely painful and stressful, but we gave it a shot. We also tried lunges and squats, but it was neither turning nor descending. At 7:45 we still had a sideways baby, I was still at the eight centimeters I’d measured at noon, and my contractions were slowing down yet again. I asked to talk to Heather about our options, and Eric went to get her. She was wonderful, straightforward and obviously emotionally involved in the problem. She acknowledged that we had no good options and that she didn’t know what would be the best choice, and she talked through everything with us and gave us time by ourselves, too. We were so tired that we had to call her back into the room to clarify a few points, and we were also so worn out that I started crying (the only tears I shed during this entire process), and then so did Eric (the second time I’ve ever seen him cry). Together, we all decided to try breaking my water. We were exhausted, and it was the most aggressive thing we could try to make me able to give birth at the birth center before I just absolutely fell apart. There were a number of risks involved—especially that we would find particulate meconium in the fluid, a real possibility because I was so overdue. That discovery would have required an immediate hospital transfer and interventions including invasive monitoring, which might have led to a pitocin augmentation and quite possibly a c-section because of the continuing sideways position. Eric and I went out to tell Mom and Jennifer what was happening (the first time I’d seen them since about six that morning when I’d greeted Jennifer), and then Heather and Cheryl broke my water, a painless but odd-feeling experience. I’ve rarely seen anyone look as happy as Heather when she squealed and told us that the fluid was completely clear and furthermore that, lo and behold, the fetus had turned! It was posterior, but I was more than happy to take a painful back labor rather than the very real chance that a sideways head simply wouldn’t fit through my pelvis. I quickly progressed to nine centimeters after being at eight since noon. At eight o’clock, Cheryl’s shift ended, and Erin came on; I joked with her about meeting me during the part of labor when I had sort of lost my mind. I was so out of it that I didn’t actually know her name until the next morning. I think it was around this point that I announced emphatically to Heather and Eric, “This is crap.”
Then my labor stalled the third time. Three hours into transition, Heather asked if I wanted an IV for fluids and sugars. She had to ask me several times before I realized she was there and managed to hear the whole sentence; I ended up deferring to Eric’s judgment because I was no longer really conscious or rational. I just couldn’t think through the deeply disorienting pain, and unlike during the rest of my labor, there was no pause of relative comfort and clarity between bouts of feeling like I was being mowed down by a truck. I could no longer make eye contact with Eric, relax my shoulders and face, walk, or otherwise actively manage the contractions. Before transition, Eric had realized that I was using him as my focal point and also realized that if he could get me to look at him I would instantly relax and actually be able to hear him. So he’d touch my face, or my hand as I walked by when he was sitting or lying on the bed, or walk with me, sometimes by my side but sometimes backwards in front of me like a tour guide, or (when I wasn’t so far gone) just say my name in a certain tone. I couldn’t make eye contact with anyone else during my contractions, even when I was still at home, but looking into his eyes made me, as always, feel safe and more centered. In the tub in early transition, though, I just lost touch, and when he asked me to look at him I mostly squeaked out “I can’t” or couldn’t respond at all.
During transition I had started hallucinating and was always surprised to see Eric, Heather, or Erin when they managed to get through to me. [While this detail did not appear in my original birth story, I feel compelled to mention that what I hallucinated was slices--well, more like sticks--of raw zucchini on a plate, which I'd count off during the part of each contraction that felt more normal and then lose track of during the next part. It was extraordinarily strange.] Fortunately, Eric was still awake enough to know the IV would be good. I hadn’t eaten at all since Wednesday evening (Eric had just had some organic pizza bites and a pear and probably needed his own IV) and, though I’d sipped on juice and both sparkling and still water earlier in my labor, hadn’t been able to make myself drink anything during transition. I was very dehydrated and am sure I felt better after the birth, as well as being able to push with more energy as Heather had hoped, because of the IV—but it was unpleasant as hell to lay on the bed without moving during all this pain while Erin hooked up my arm, and I’m squeamish about IVs under the best of circumstances.
I had one bout of light pushing from 11:45 until 1:15. Heather said I could push a little during contractions (not holding my breath or anything, just pushing at the peak) because it helped with the pain so much; that provided a much-needed respite but didn’t lead anywhere in terms of actual progress toward the birth. For some reason the fetus just wouldn’t descend. At 1:15 Heather again suggested Nubain, I again deferred to Eric’s decision, and Erin injected a quarter dose—not enough to stop me feeling pain, but hopefully enough to give me a little rest and keep me from crashing instead of being able to push when the time came. At this point a violent thunderstorm had broken out, and Eric and I made eye contact and laughed a little at the thunder and lightning, like ‘what else?’ Jennifer later told me that Heather and Erin had been very worried about losing power and were trying to figure out what we should do if that happened. After a little while I struggled to ask how long the Nubain was supposed to take to kick in, as it had done absolutely nothing; Erin gave me another quarter dose. We fell asleep with me waking up to frequent, still uncontrollably painful, contractions, which at this point I was experiencing outside language. I usually think in sentences, so this imagistic world of pain was very strange for me. These contractions each involved the most intense contraction I’ve ever had, in the now-normal pattern of build up and down, followed immediately by excruciating and unmanageable lower back and hip pain for a seemingly endless period after each more familiar arch. I could sort of count off the first part, knowing that each one took at least five long series of screams/moans, but I just dropped off the face of the earth during the second part and could only writhe in pain. Meanwhile, Eric was more or less sleeping, on no pillows (I had them all), with his ear a few inches away from my mouth.
After about an hour and a half, so around 2:15, I woke up scared, feeling very different—I was in less pain and expected that good progress would involve more and more pain until the child was out of my body, and I was terrified that my labor and the fetus had somehow regressed. My hips and back had stopped hurting, and I didn’t feel anything like what I had come to know as contractions. I felt other very weird pressure (as though the fetus were kicking me really hard in the butt from the inside) but didn’t know what to make of it. I woke Eric, both of us totally disoriented, by yelling to go get the midwife or nurse (“one of them” was the best I could do—I had no idea what their names were at that point—and when he asked why I responded “I don’t know. I feel weird”). Eric later told me that, when he got to the door half-asleep, they were already standing up to come in because they’d heard me. At first Heather thought I just meant I was scared at hurting so much and/or impatient, and she started encouraging me to get a little more sleep. It was extremely difficult for me to communicate clearly at that point, but as I struggled to explain the sensation I was having, Heather and Erin both looked like they were having a moment of realization. Without telling me what she was looking for (presumably so I wouldn’t just kill myself if they were wrong), Heather checked my cervix and shocked me with the excellent news that I was at way over nine centimeters and at two station and could start pushing in earnest.
The actual birth was just wonderful, after all the hell of transition and all the delays. After she checked me and said I could start pushing, Heather asked if that was what I wanted to do; I said I would but that I didn’t know how, so they’d have to tell me. I started out more flat on my back than I wanted to be, because we went straight from the exam into pushing, so they propped me up on one side with a pillow. Eric, Erin, and Heather at various times helped me hold my leg how I wanted it. I asked them to keep me still rather than letting my leg relax between contractions; it hurt to move or be moved at that point, and I liked the stability and the readiness for the next contraction, when I could push again. I did not like taking breaks, though I understood I needed to breathe and allow my tissue to stretch.
I could tell when a contraction began, though not really consciously or rationally—they weren’t painful like the previous fifty hours of contractions, and I’d just get a vague feeling that I’d be allowed to push again if I tried. But I couldn’t tell at all when one stopped. I had to ask whether I was still contracted or could keep pushing. Erin answered the first couple times by putting her hand on my belly, but it became Eric’s job to feel my belly and tell me when to take a break and breathe. I remember him saying a few times, “You can do one more.” He was on my left side, sitting on the bed and touching me, talking to me and to Heather. He was still in his swim trunks from when I had labored in the tub six hours or so earlier; with lots of his help, I had managed to get my skirt and a sleep bra back on after the bath and had been putting on and taking off Eric’s old flannel shirt (and making Erin turn the ceiling fan on and off) ever since, as waves of extreme hot and cold washed over me. Heather and Erin gave a sort of running commentary and told me when I was doing particularly well. Heather tended to say “Perfect” in this very calm, assertive voice, and they both commented to each other on my “control”; apparently for whatever reason I have excellent muscular control and was able to use only the muscles I needed, which is the factor to which Heather and Erin most attribute the fact that I ended up not tearing at all. At any rate, I expected that sort of cheering to annoy the shit out of me and seem patronizing or false, but as it turns out, I really needed and wanted it. I remember one bout of pushing when no one said anything to me, and I thought about saying I needed more feedback and encouragement. Early on, Heather told me to put my chin to my chest and make a “c” shape with my back when I pushed, but other than that everyone just helped me do what I wanted and needed to do—which was how the whole labor went, actually.
These memories are far more lucid and specific than my memories of the preceding hours. I was surprised at how little this stage hurt and simultaneously how much I could feel: I could really specifically feel the head and body emerging gradually, the warm oil Heather poured on me a couple times to help ease them out, the head stretching my tissue when Eric made me pause. I could feel that I wasn’t tearing. The only pain I felt was a too-fast-stretching sort of sensation when I had to take quick breaks from pushing. A couple times it really hurt, but nothing like even my earlier contractions, or like a migraine—it was just normal, manageable, understandable pain. I could think through it rather than feeling disoriented or overwhelmed.
And I could see Eric getting excited! He had been so physically and emotionally worn out. As he perked back up and was able to help me—and as we were both able to see the birth as a real possibility again (labor had started to seem potentially eternal, at least to me)—he started talking to Heather about real, concrete things that happen when you actually have an actual baby: catching the baby, wiping it off a little before handing it to me, cutting the cord, what to do with the placenta. His face started to look different, calm and happy and enthusiastic instead of exhausted and concerned. It was wonderful to see and hear all of that, and to be confident, lucid, and active again myself.
After the rest of my labor, the pushing felt extremely quick. I am amused to remember that after a couple times of Erin saying “Give this one just a little more” near the end of a push—and me finding I actually could push harder, though I’d felt I was doing my all—I very clearly thought “I’m going to give it a little more every time.” It was so good to come back to my own dorky personality, to thinking in language and being able to do something, to work hard and do a good job, to have the birth in sight. During transition it had felt like all I was doing was not dying.
So eventually Heather could see the head while I was pushing, and then they could see it all the time. She asked if I wanted to touch it, and I joked about touching it once it was all out. And then Heather helped the head and shoulders out, and Eric took over from there; while he held our baby for the last of the pushing, I saw Heather take the cord, loosely wrapped around the neck, over the head. The child was screaming and wriggling as it came all the way out; after all the problems, Noah was born in a perfect anterior position. A few moments later I asked, “What is it? What’s its name?” No one had thought about that part yet, and they all looked at each other and turned over the squirmy, upside-down baby. Eric said something slightly hesitant like “It’s a boy, right?” and Heather confirmed. Then he smiled and said “It’s Noah!” Erin quickly wiped him off and handed him to me while Heather got me to deliver the placenta, which took five or ten minutes and no effort or attention on my part (except that I saw it and commented that it was gross). I was vividly aware that the labor was finally over. Hours and hours before, “You’re going to have a baby” had ceased to be a compelling incentive (at some point Heather said that between contractions, and I laughed and said “I’m starting not to believe that; I don’t see any freakin’ babies”), but the end of labor had remained a big goal. Now I was able to be with Eric and Noah outside all that pain. I kissed my screaming son’s forehead—the first two times he stopped crying were the first two times I kissed him—and talked to him, and smiled up at Eric’s face, and felt incredible.
labor & birth
birth stories online
What does giving birth feel like? (Stand and Deliver; read the many comments as well as the post)
My own first and second birthing stories (First the Egg)
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Why on earth would anyone want to have an unmedicated birth? (First the Egg, below)
“Clarifying Your Feelings about Pain and Medications in Childbirth” (PDF; Penny Simkin via Childbirth Connection)
What should I expect with an epidural? (Our Bodies, Ourselves: Pregnancy and Birth)
What can my partner/friend/doula/whomever do to support me if I have an epidural? Or: why would I want labor support even if I plan to use epidural pain relief? Or: I’m supporting someone who plans to use epidural anesthesia. How can I help? (Mother Birth; the short & sweet answer: “While an epidural relieves most of the physical pain, it does not affect your need for emotional support, information or reassurance.”)
I want or need an epidural. What can I try doing to avoid potential problems? (Prenatal Yoga Center)
What pain medications are commonly used during labor, and what are some benefits and risks of using them? (MayoClinic.com)
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Am I in labor? (PDF; “Share With Women,” Journal of Midwifery & Women’s Health)
When will my water break? Or: My water broke: what’s next? (PDF; “Share With Women,” Journal of Midwifery & Women’s Health)
What are intermittent and continuous fetal monitoring, and why does the difference matter? (Our Bodies, Ourselves: Pregnancy and Birth)
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“Let labor begin on its own” video PDF (Lamaze International and Mother’s Advocate)
Some points to consider about inducing labor (PDF; “Share With Women,” Journal of Midwifery & Women’s Health)
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What exactly happens during a c-section, step by step? (Rebirth Nurse)
“Women of Size and Cesarean Sections: Tips for Avoiding Unnecessary Surgery” (Our Bodies, Ourselves Health Resource Center)
International Cesarean Awareness Network (ICAN): information on avoiding unnecessary surgery, post-cesarean recovery, and vaginal birth after cesarean (VBAC)
“How to Get out of Bed Post Cesarean” (Rebirth Nurse)
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How does the pushing/birth part of labor (“stage 2”) work? (Childbirth Connection)
“Avoid giving birth on your back and follow your body’s urges to push” video and PDF
If it’s not so great to push and give birth on my back with my feet in stirrups, what are some effective positions? (“Holistic Pregnancy and Childbirth,” University of Minnesota)
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“Keep mother and baby together - It’s best for mother, baby and breastfeeding” video and PDF (Lamaze International and Mother’s Advocate)
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What is birth trauma? (The Birth Trauma Association)
Common misunderstandings about birth trauma (Birthing Beautiful Ideas)
Excellent reasons not to say “You have a healthy baby, and that’s all that matters” (Birthing Beautiful Ideas)
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I know a lot of women who have assumed from adolescence that they would have an epidural during childbirth, some of whom are well-educated about that decision and some of whom imagine that having an epidural means they’ll somehow have a completely pain-free and safe birth. I think everyone understands why some women choose to have various pain medications during a painful and, for many, scary experience; it’s not exactly inexplicable to think “hey, I’m in pain; can I have some pain medication?” But, on the other hand, a lot of people have absolutely no idea why anyone in her right mind would choose to experience birth without pharmaceutical interventions to manage pain. From “I could never do that” to implications that unmedicated childbirth is masochistic and/or sadistic, many responses to this choice seem to imply that their utterers are at a loss to explain such bizarre behavior.
So, judging from my own experience, other people’s stories, and books and articles that deal with choices in childbirth, here are some of the reasons that some non-masochistic women might prefer to avoid drugs while they labor, with the help of their non-sadistic yet supportive partners/caregivers/doulas:
Okay, I’ll stop. There are other reasons, too; these are just some that come to mind for me. Most women who plan unmedicated births probably do so for multiple reasons (I certainly did). None of these reasons applies to everyone or means that all women ought to want unmedicated births. But I do hope they illustrate that the choice can be a reasonable, valuable, earnest one that should be honored on its own terms rather than dismissed, and that it can mean lots of different things to different women, just like every choice in childbirth.
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14 July 2008
Two years ago today, I gave birth to my first (and, so far, only) child. I recently reread my birth story, which I wrote during the couple days after the birth (based on my memories and my husband’s detailed notes) and have copied below without any changes. It’s so moving for me to read this narrative and feel all those feelings again, to live with myself through the long, hard labor and triumphant shift into pushing and then new life, and to witness again my partner’s almost-unbelievable attention, competence, and kindness.
But it’s also fascinating to read my own story now that I know so much more about it. All these details are correct, but now I know what they mean in a way that I didn’t at the time. I know how amazing it is that these midwives let my body do what it needed to do. I notice that my least pleasant memories correlate awfully strongly with the very few interventions we did do, all in a totally good-faith effort shared by our caregivers and us to keep me out of the hospital in a system that does not accept more-than-two-weeks-’overdue’ and several-days-long, “stalling” labors (various ‘natural’ induction efforts when my body and fetus may not have been quite ready but were teetering at the brink of the birth center’s protocol at two weeks past my ‘due date,’ AROM (‘breaking my water’) leading to intense transition when my body and the fetus’s position were maybe not ready to go there yet, low-dose Nubain ‘to help me rest’ that I now suspect led to the disorientation and confusing hallucinations that can be a side effect of that drug). I realize how strange and challenging it was to spend over a complete work day in transition. I see how parts of my labor were ‘back labor,’ and understand how hard it would be to experience that throughout an entire labor. I hear the midwife, so pleased to find that my cervix had finally dilated almost completely, telling me that I could push and asking if that’s what I wanted to do. I hear what I didn’t write down–both midwives letting me choose whether and when they performed pelvic exams, without exception. Indeed, I hear everyone involved in this story asking me, after every suggestion and each of my questions, what I wanted to do.
Most of all, I now cherish–in a way I didn’t know I needed to do, back when this story constituted my entire knowledge of our birth culture–the long minutes of absolute silence and the respectful, kind, soft words that surrounded my son’s birth. The calm of my husband and caregivers. The simple, earnest answer I received a couple weeks ago from my husband, when I said I have become amazed at all the beautiful silence: “Well, we were all paying attention to you.” As in, how could we have had the attention to attend to you and make a bunch of noise at the same time? As in, what noise would we have been making while you were busy bringing a child into the world, perfectly, on your own but surrounded by support?
That’s exactly right, sweetheart. (And happy becoming-a-parent day to you!)
And yet so many births in our culture–even low-risk, unmedicated births–are as brightly-lit as surgeries and as loud as sports events, in rooms overflowing with strangers in masks carrying ‘implements,’ and not a soul paying any attention to the laboring woman’s feelings, words, or face. I am so fortunate and so happy in my birth memories; they make me feel nothing but strong and loved.
Here’s our story.
Noah was born at 2:58 on the morning of Friday, 14 July 2006, two weeks and four days after his 26 June due date and after a fifty-one hour labor. I was amused to see later that morning, on the birth certificate form in the statistical section, that my labor is classified as “extended” and “dysfunctional.” Apparently anything over twenty hours is “extended,” so we certainly made that one—we were already at the birth center twenty-two hours before Noah actually emerged into the outside world. My labor was the most painful and among the most difficult, but also among the most fulfilling and romantic, experiences I’ve ever had.
Eric and I went into the labor exhausted because, by necessity, we’d been increasingly obsessed with the pregnancy and whether it was in fact ever going to end. By Noah’s birth, we had been at the birth center every day for six consecutive business days for various check-ups and tests and had gone to the hospital for two ultrasounds to monitor my amniotic fluid level and how well my aging placenta was working. We had tried a number of more or less natural induction methods, including getting up at 5:30 on Tuesday morning for me to take castor oil, which resulted in more contractions and lots of stomach unpleasantness but not labor. That was the beginning of our serious sleep deprivation; at midnight that night my labor began, although it would stop progressing three times before the birth, and in the three and a half days from 5:30 Tuesday morning until eight o’clock Friday evening I would get about six hours of sleep, most of that punctuated by contractions every few minutes and thus not really ‘sleep’ in the traditional sense of being restful. Eric was in about the same boat as me. And I had insisted on walking and walking and walking in the last days of my pregnancy and then through almost all of my contractions.
By Wednesday morning my contractions had progressed from about every six minutes to about every four minutes, and we were excited; we had been told we’d go to the birth center when they were patterned at about three minutes apart. The midwife on call suggested we come in around nine o’clock when Maureen’s shift started, so she could check me and we could make a plan. I had made progress, and Maureen suggested we get a little rest before coming in (as, presumably, my labor continued to progress); I took two Tylenol and a Benadryl as directed and at first had rather nightmarish sleep broken up by searing contractions. But after noon or so I woke shocked to find that it was two o’clock. My contractions seemed to have stopped, and, both very worried, we called Maureen about this stalled progress. At this point Eric was already saying he had never seen me so exhausted. I had called my mom that morning, when birth looked relatively imminent; she arrived at the airport at three o’clock, and our friend Jennifer picked her up and brought her to our apartment to find us out walking—which had sometimes sped up my contractions and gotten them into a clearer pattern.
I continued to have scattered rather than patterned contractions, some quite painful and some just uncomfortable, usually between six and fifteen minutes apart, until they picked back up around nine o’clock that evening. By three that morning I hurt significantly and, though my contractions were still about six minutes apart, called the birth center for help with pain management. I had taken showers but not yet a bath (out of fear that it might again slow my labor), and Jill, the nurse on call, suggested that a bath could be helpful. During that bath as my contractions intensified and sped up to intervals of 3-5 minutes; all along my contractions had lasted about 75 seconds to two minutes each, so they never did really progress in terms of length. Anyway, Eric read to me from The Hobbit part of the time, and he sat at the edge of the tub and helped me as I wiggled and swayed through these increasingly intense waves, some of which peaked twice, always an unpleasant surprise. I stayed in the tub most of the time until nearly five, when Eric noticed that the contractions had sped up considerably and timed five more; I called the birth center again and was told to come on in. I called my dad and Eric called Jennifer, who left to meet us at the birth center; on the way, Eric also called his parents. When the three of us got into the car (Mom next to the car seat we’d been driving around for five weeks already), I popped right back out to walk through another contraction because I knew I hated being pinned helplessly into the car during that pain. I was grateful to have such a short drive and only to have one contraction in the car, another starting as we pulled into the parking lot.
We walked in to find Maureen and meet Jill, and to find me dilated yet another centimeter (5-6 at this point), 100% effaced, and at zero station. They drew me a bath, and Eric turned on our wedding music. (Hours later I asked him to play Finding Nemo in the background, and we ended up listening to our wedding music about three times.) He smiled and told me it was my time to shine. At 7:30 I threw up for the first time and was already trying to use the birth ball a little as a break from walking; I ended up mostly laboring walking, but occasionally between or during contractions I would try to rest by being on the ball (or by propping myself up, nearly standing, against lots of pillows on the edge of the bed, ready to start walking again when the pain began). I sometimes jumped up from the pain, which I only really found manageable with my body upright and in motion. Jill and Maureen watched me work through a couple contractions, apparently to see whether it was really a good idea to follow our birth plan and leave us more or less alone until we asked for help (or whether we needed some advice or coaching before that); Jill told us we seem like a great couple and told me, “You seem like a pro. You wouldn’t know this was your first baby.” At eight o’clock Maureen and Jill were replaced by Heather and Cheryl. By 10:30 I had dilated another centimeter and was pleased to be making real though gradual progress.
It’s hard to believe now that by eleven that morning Heather had already offered me a little Nubain for my pain and exhaustion; I said I was okay for the time being. For a while we had both been tired enough to pass out for the moments between contractions, but as it got to be a time of day when we’re normally up and alert, we became more lucid. At noon Eric and I still felt confident and optimistic and could see my belly dropping significantly—I remember seeing my profile in the mirror and pulling up my grey t-shirt to observe that my belly had sort of a flat shelf on top where everything was lower, and Eric noticed that I was bulging over my hip bones rather than under my ribs. Heather and Cheryl kept telling me how well I was doing when they came in to check the fetal heart rate (always very strong) and so forth. I just kept walking, up and down the room from the bathroom door back to the sink, and around the rocking chair / birth ball area we’d set up. Near one o’clock we felt upbeat enough to laugh and dance briefly to a Louis Armstrong song, and soon we found I was at eight centimeters, though still at zero station. I remember asking at that point something like, “A lot of women go from eight to ten really quickly, right?” and Heather saying yes, that’s common. Again, we were excited and ready to go. We had come into the birth center guessing we’d have a baby by noon or so, and now we thought surely it would happen by five.
But at 4:30 that afternoon I was still at eight centimeters, and for about half an hour my contractions had stopped getting more intense and instead became less patterned; I would have two or three one right after the other and then several minutes before the next one. Heather discussed possible interventions with us—black and blue cohosh drops, which would take a long time either to work or not to work; using a breast pump to stimulate contractions that hopefully would be more productive and organized; breaking my water; or going to the hospital for a pitocin induction and/or cesarean section, which we all hoped to avoid. Pumping usually works and has no particular downside in that we could try the other methods if it failed to get me progressing, so that was our choice. Heather told us that she or Cheryl could help me use the pump, or that they could show us how and Eric could help me. So Cheryl explained how it worked, and I sat on the birth ball facing Eric in the rocking chair while he read more from The Hobbit to distract me when possible. (One of the enormous benefits of the birth center was that they actually read and honored our birth plan, including our desire to be alone together and my request that they always knock before coming into the room. Eric and I had real privacy during this experience, which I think is unusual.) We were supposed to do ten minutes on, ten off, until the contractions pulled together or for an hour. The first twenty minutes involved several normal, intense contractions and were encouraging, but the second time, I just contracted straight through the ten minutes of pumping. We told Cheryl, who said we needed to stop because my body was responding too strongly and that contractions that long weren’t good for anybody. We were encouraged, though, to find my contractions back to their former intensity and frequency. Around six o’clock, Cheryl told me that my dad had called, that they couldn’t give him much information but told him I was still in labor there and working hard, and that he sent his love; he later told me he knew they wouldn’t be able to tell him anything but also knew that if I was still at the birth center, I was okay.
Meanwhile, everyone was hoping that the fetus, who didn’t seem to want to become a baby, would turn from a sideways position. We tried manipulating my belly during and between contractions; staying still and being messed with during contractions was extremely painful and stressful, but we gave it a shot. We also tried lunges and squats, but it was neither turning nor descending. At 7:45 we still had a sideways baby, I was still at the eight centimeters I’d measured at noon, and my contractions were slowing down yet again. I asked to talk to Heather about our options, and Eric went to get her. She was wonderful, straightforward and obviously emotionally involved in the problem. She acknowledged that we had no good options and that she didn’t know what would be the best choice, and she talked through everything with us and gave us time by ourselves, too. We were so tired that we had to call her back into the room to clarify a few points, and we were also so worn out that I started crying (the only tears I shed during this entire process), and then so did Eric (the second time I’ve ever seen him cry). Together, we all decided to try breaking my water. We were exhausted, and it was the most aggressive thing we could try to make me able to give birth at the birth center before I just absolutely fell apart. There were a number of risks involved—especially that we would find particulate meconium in the fluid, a real possibility because I was so overdue. That discovery would have required an immediate hospital transfer and interventions including invasive monitoring, which might have led to a pitocin augmentation and quite possibly a c-section because of the continuing sideways position. Eric and I went out to tell Mom and Jennifer what was happening (the first time I’d seen them since about six that morning when I’d greeted Jennifer), and then Heather and Cheryl broke my water, a painless but odd-feeling experience. I’ve rarely seen anyone look as happy as Heather when she squealed and told us that the fluid was completely clear and furthermore that, lo and behold, the fetus had turned! It was posterior, but I was more than happy to take a painful back labor rather than the very real chance that a sideways head simply wouldn’t fit through my pelvis. I quickly progressed to nine centimeters after being at eight since noon. At eight o’clock, Cheryl’s shift ended, and Erin came on; I joked with her about meeting me during the part of labor when I had sort of lost my mind. I was so out of it that I didn’t actually know her name until the next morning. I think it was around this point that I announced emphatically to Heather and Eric, “This is crap.”
Then my labor stalled the third time. Three hours into transition, Heather asked if I wanted an IV for fluids and sugars. She had to ask me several times before I realized she was there and managed to hear the whole sentence; I ended up deferring to Eric’s judgment because I was no longer really conscious or rational. I just couldn’t think through the deeply disorienting pain, and unlike during the rest of my labor, there was no pause of relative comfort and clarity between bouts of feeling like I was being mowed down by a truck. I could no longer make eye contact with Eric, relax my shoulders and face, walk, or otherwise actively manage the contractions. Before transition, Eric had realized that I was using him as my focal point and also realized that if he could get me to look at him I would instantly relax and actually be able to hear him. So he’d touch my face, or my hand as I walked by when he was sitting or lying on the bed, or walk with me, sometimes by my side but sometimes backwards in front of me like a tour guide, or (when I wasn’t so far gone) just say my name in a certain tone. I couldn’t make eye contact with anyone else during my contractions, even when I was still at home, but looking into his eyes made me, as always, feel safe and more centered. In the tub in early transition, though, I just lost touch, and when he asked me to look at him I mostly squeaked out “I can’t” or couldn’t respond at all.
During transition I had started hallucinating and was always surprised to see Eric, Heather, or Erin when they managed to get through to me. [While this detail did not appear in my original birth story, I feel compelled to mention that what I hallucinated was slices--well, more like sticks--of raw zucchini on a plate, which I'd count off during the part of each contraction that felt more normal and then lose track of during the next part. It was extraordinarily strange.] Fortunately, Eric was still awake enough to know the IV would be good. I hadn’t eaten at all since Wednesday evening (Eric had just had some organic pizza bites and a pear and probably needed his own IV) and, though I’d sipped on juice and both sparkling and still water earlier in my labor, hadn’t been able to make myself drink anything during transition. I was very dehydrated and am sure I felt better after the birth, as well as being able to push with more energy as Heather had hoped, because of the IV—but it was unpleasant as hell to lay on the bed without moving during all this pain while Erin hooked up my arm, and I’m squeamish about IVs under the best of circumstances.
I had one bout of light pushing from 11:45 until 1:15. Heather said I could push a little during contractions (not holding my breath or anything, just pushing at the peak) because it helped with the pain so much; that provided a much-needed respite but didn’t lead anywhere in terms of actual progress toward the birth. For some reason the fetus just wouldn’t descend. At 1:15 Heather again suggested Nubain, I again deferred to Eric’s decision, and Erin injected a quarter dose—not enough to stop me feeling pain, but hopefully enough to give me a little rest and keep me from crashing instead of being able to push when the time came. At this point a violent thunderstorm had broken out, and Eric and I made eye contact and laughed a little at the thunder and lightning, like ‘what else?’ Jennifer later told me that Heather and Erin had been very worried about losing power and were trying to figure out what we should do if that happened. After a little while I struggled to ask how long the Nubain was supposed to take to kick in, as it had done absolutely nothing; Erin gave me another quarter dose. We fell asleep with me waking up to frequent, still uncontrollably painful, contractions, which at this point I was experiencing outside language. I usually think in sentences, so this imagistic world of pain was very strange for me. These contractions each involved the most intense contraction I’ve ever had, in the now-normal pattern of build up and down, followed immediately by excruciating and unmanageable lower back and hip pain for a seemingly endless period after each more familiar arch. I could sort of count off the first part, knowing that each one took at least five long series of screams/moans, but I just dropped off the face of the earth during the second part and could only writhe in pain. Meanwhile, Eric was more or less sleeping, on no pillows (I had them all), with his ear a few inches away from my mouth.
After about an hour and a half, so around 2:15, I woke up scared, feeling very different—I was in less pain and expected that good progress would involve more and more pain until the child was out of my body, and I was terrified that my labor and the fetus had somehow regressed. My hips and back had stopped hurting, and I didn’t feel anything like what I had come to know as contractions. I felt other very weird pressure (as though the fetus were kicking me really hard in the butt from the inside) but didn’t know what to make of it. I woke Eric, both of us totally disoriented, by yelling to go get the midwife or nurse (“one of them” was the best I could do—I had no idea what their names were at that point—and when he asked why I responded “I don’t know. I feel weird”). Eric later told me that, when he got to the door half-asleep, they were already standing up to come in because they’d heard me. At first Heather thought I just meant I was scared at hurting so much and/or impatient, and she started encouraging me to get a little more sleep. It was extremely difficult for me to communicate clearly at that point, but as I struggled to explain the sensation I was having, Heather and Erin both looked like they were having a moment of realization. Without telling me what she was looking for (presumably so I wouldn’t just kill myself if they were wrong), Heather checked my cervix and shocked me with the excellent news that I was at way over nine centimeters and at two station and could start pushing in earnest.
The actual birth was just wonderful, after all the hell of transition and all the delays. After she checked me and said I could start pushing, Heather asked if that was what I wanted to do; I said I would but that I didn’t know how, so they’d have to tell me. I started out more flat on my back than I wanted to be, because we went straight from the exam into pushing, so they propped me up on one side with a pillow. Eric, Erin, and Heather at various times helped me hold my leg how I wanted it. I asked them to keep me still rather than letting my leg relax between contractions; it hurt to move or be moved at that point, and I liked the stability and the readiness for the next contraction, when I could push again. I did not like taking breaks, though I understood I needed to breathe and allow my tissue to stretch.
I could tell when a contraction began, though not really consciously or rationally—they weren’t painful like the previous fifty hours of contractions, and I’d just get a vague feeling that I’d be allowed to push again if I tried. But I couldn’t tell at all when one stopped. I had to ask whether I was still contracted or could keep pushing. Erin answered the first couple times by putting her hand on my belly, but it became Eric’s job to feel my belly and tell me when to take a break and breathe. I remember him saying a few times, “You can do one more.” He was on my left side, sitting on the bed and touching me, talking to me and to Heather. He was still in his swim trunks from when I had labored in the tub six hours or so earlier; with lots of his help, I had managed to get my skirt and a sleep bra back on after the bath and had been putting on and taking off Eric’s old flannel shirt (and making Erin turn the ceiling fan on and off) ever since, as waves of extreme hot and cold washed over me. Heather and Erin gave a sort of running commentary and told me when I was doing particularly well. Heather tended to say “Perfect” in this very calm, assertive voice, and they both commented to each other on my “control”; apparently for whatever reason I have excellent muscular control and was able to use only the muscles I needed, which is the factor to which Heather and Erin most attribute the fact that I ended up not tearing at all. At any rate, I expected that sort of cheering to annoy the shit out of me and seem patronizing or false, but as it turns out, I really needed and wanted it. I remember one bout of pushing when no one said anything to me, and I thought about saying I needed more feedback and encouragement. Early on, Heather told me to put my chin to my chest and make a “c” shape with my back when I pushed, but other than that everyone just helped me do what I wanted and needed to do—which was how the whole labor went, actually.
These memories are far more lucid and specific than my memories of the preceding hours. I was surprised at how little this stage hurt and simultaneously how much I could feel: I could really specifically feel the head and body emerging gradually, the warm oil Heather poured on me a couple times to help ease them out, the head stretching my tissue when Eric made me pause. I could feel that I wasn’t tearing. The only pain I felt was a too-fast-stretching sort of sensation when I had to take quick breaks from pushing. A couple times it really hurt, but nothing like even my earlier contractions, or like a migraine—it was just normal, manageable, understandable pain. I could think through it rather than feeling disoriented or overwhelmed.
And I could see Eric getting excited! He had been so physically and emotionally worn out. As he perked back up and was able to help me—and as we were both able to see the birth as a real possibility again (labor had started to seem potentially eternal, at least to me)—he started talking to Heather about real, concrete things that happen when you actually have an actual baby: catching the baby, wiping it off a little before handing it to me, cutting the cord, what to do with the placenta. His face started to look different, calm and happy and enthusiastic instead of exhausted and concerned. It was wonderful to see and hear all of that, and to be confident, lucid, and active again myself.
After the rest of my labor, the pushing felt extremely quick. I am amused to remember that after a couple times of Erin saying “Give this one just a little more” near the end of a push—and me finding I actually could push harder, though I’d felt I was doing my all—I very clearly thought “I’m going to give it a little more every time.” It was so good to come back to my own dorky personality, to thinking in language and being able to do something, to work hard and do a good job, to have the birth in sight. During transition it had felt like all I was doing was not dying.
So eventually Heather could see the head while I was pushing, and then they could see it all the time. She asked if I wanted to touch it, and I joked about touching it once it was all out. And then Heather helped the head and shoulders out, and Eric took over from there; while he held our baby for the last of the pushing, I saw Heather take the cord, loosely wrapped around the neck, over the head. The child was screaming and wriggling as it came all the way out; after all the problems, Noah was born in a perfect anterior position. A few moments later I asked, “What is it? What’s its name?” No one had thought about that part yet, and they all looked at each other and turned over the squirmy, upside-down baby. Eric said something slightly hesitant like “It’s a boy, right?” and Heather confirmed. Then he smiled and said “It’s Noah!” Erin quickly wiped him off and handed him to me while Heather got me to deliver the placenta, which took five or ten minutes and no effort or attention on my part (except that I saw it and commented that it was gross). I was vividly aware that the labor was finally over. Hours and hours before, “You’re going to have a baby” had ceased to be a compelling incentive (at some point Heather said that between contractions, and I laughed and said “I’m starting not to believe that; I don’t see any freakin’ babies”), but the end of labor had remained a big goal. Now I was able to be with Eric and Noah outside all that pain. I kissed my screaming son’s forehead—the first two times he stopped crying were the first two times I kissed him—and talked to him, and smiled up at Eric’s face, and felt incredible.
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Page last updated: 26 July 2012